complication &acl revision
DESCRIPTION
Complication &ACL revision. Time . Intraop . complications. Surgical tech. errors. Tunnel placement Inadequate notchplasty Graft selection& size - PowerPoint PPT PresentationTRANSCRIPT
Complication &ACL revision
Time
Minimal or no swelling
Leg control
Full ROM
Intraop. complications
Tunnel malposition
Improper tensioning
Fix. Problem
Graft impingement
Surgical tech. errors• Tunnel placement
• Inadequate notchplasty
• Graft selection& size
• Tensioning
• Fix failure:
Poor bone quality,screw breakage,screw divergence & graft damage
Tunnel malposition
• Femur Ant. Position & post. Position & vertical• Tibial ant. & post position
Blumensaat,s line
Graft tensioning
• Inadequate tensioning• Overtensioning StiffnesGraft stretchingStress on cartilagePoor vascularity
Fixation
• Screw• Transfix• endobutton
Graft impingement
• NotchplastyPostop painBleedingSwellingregrowth
Postop problems• Persistent Ant Knee
Pain 0 34%• Motion deficits
1 13%
• Arthrofibrosis
• Graft failure
• Osteoarthritis
• DVT Infection
Ant Knee pain
• Flex contracture>10• Q weakness • BPTB G short imobilization,early &proper PT
Loss of motion
• Tunnel malposition• Prolonged immobilization• Poor patient compliance• RSD• Too early recons.• Inadequate notchplasty• Concomitant surgeryPT, steroid, manipulation,arthroscopy & revision
Graft specific complications
• BPTBG: Ant knee pain,kneeling pain,flex contracture,patellar fx,tunnel mismatch,graft fx,suture laceration,post cortex fx
• Hamstring : Short graft Saphen n. injury H. WeaknessTunnel widening Allograft :
ACL recon. failure
• Retearing & instability• Loss of motion• Persistent pain
Revision of ACLCause of failurePatient selectionMotivation & expectationTime of surgerySurgical techGraft selectionG incorporationSecondary restraint(medial & posterolat)Meniscal& cartilage conditionRehabilitationSecond traumaMotion loss flex cont>10 & end of flex>20Lower extrimity alignment
Preop. Planning of instability
• Cause of failureHistory & ph. Exam.& imaging(AP,lat,MRI,CT,Long standing alignment view)• Good ROM• Low swelling• Good mucle strength• Graft selection• Tunnel place & widening& previos device• One stage or two stageLoss of ext>5 limited flex >20Widening>15mm
21/7/89---30/11/91
• 564 ACLtearing 407recon.• 25 retearing 2 reretearing
6.63%• 19 revision• Tech. error 4 21%• Recurent trauma 15 79%
complication• Hemarthrosis 10• Endo pain 4• Infection 2• Retearing 27No allograft( 33) no female(12)